Looking Back on Rear-Facing Car Seats: Surveying US Parents in 2011 and 2013.

OBJECTIVE We sought to determine the age at which US parents first turned their child's car seat to face forward and information sources used to make that decision at the time of the release of the 2011 guidelines for child passenger safety and 30 months later. METHODS We administered 2 separate cross-sectional Web-based surveys of nationally representative panels of US parents in May 2011 and November 2013. Survey participation rate was 54% in both years. Parents of children ≤4 years old responded to questions about transitioning from rear-facing to forward-facing car seats (n = 495 in 2011; n = 521 in 2013). RESULTS In 2011, 33% of parents of 1- to 4-year-old children who had been turned to face forward (n = 409) turned at or before 12 months and 16% turned at 2 years or older. In 2013, 24% of parents of 1- to 4-year-old children who had been turned to face forward (n = 413) turned at or before 12 months and 23% turned at 2 years or older. Car seat packaging and clinicians were the most common information sources. Demographic characteristics associated with turning to face forward at or before 12 months of age in 2011 (parent age, education, household income, rural residence) were not significantly associated with transitioning at or before 12 months in 2013. CONCLUSIONS Delaying the transition to a forward-facing car seat still represents an opportunity to improve passenger safety in the United States. As common sources of information, clinicians may be influential in a parent's decision to turn their child's car seat to face forward.